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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL FESSENDEN (CHIEF MEDICAL OFFICER)
(615) 401-4634
Entity
Organization

Contact information

Practice address
1340 S DAMEN AVE, SUITE 210, CHICAGO, IL 60608-1169
(773) 292-4800
(773) 384-7053
Mailing address
1340 S DAMEN AVE STE 400, CHICAGO, IL 60608-1169
(773) 292-4800
(773) 384-7053

Taxonomy

Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
213E00000X
Podiatrist

Other

Enumeration date
08/04/2005
Last updated
09/28/2020
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